AYA@USC Getaway Retreat 2023 RSVP
 Dear AYAs, thank you for your interest in joining our Getaway Retreat on Friday-Sunday, Sep 22-24, 2023 at the Camp Ronald & McDonald, Idyllwide, California.

This retreat is FREE for young adult cancer patient/survivor (ages 18-39) to join, which includes Two-night accommodation at the camp site, Workshops, Camp Activities and Entertainment, Food and Transportation.

https://rmhcsc.org/camp/page/about-our-camp-site

Please kindly complete the following information so that we can confirm your participation. For questions, please contact shuli@usc.edu. Thank you!
Camp Ronald & McDonald
Camp Rooms
Your Name *
Email Address *
Phone Number *
Are you
Clear selection
Please let us know where you are/were treated for cancer. *
Required
Age of Diagnosis *
What forms of cancer were you diagnosed with? *
Where are you from? Please provide us with your city, state and zip code. *
Who will be your emergency contact? Please provide name, relationship, phone & email *
Please provide your oncologist's name and contact information.  *
How did you hear about this retreat? *
Will you ride with us on a bus that will be leaving USC Norris Cancer Hospital on Friday, Sep 22 at 12:00 pm, returning to the hospital 5:00 pm on Sunday? The camp site is approximately 106.7 miles from the hospital. You can leave your car at USC Parking Structure during the retreat. *
Do you have any dietary restrictions? *
Do you need any special accommodations? *
What are your hobbies and favorite activities?
Why would you like to join this retreat? *
Is there anything else we need to know about you, or do you have any question regarding this retreat? *
Would you like to join our email newsletter so that you can be updated on our upcoming news & events? *
Thank you again for joining our AYA@USC community and this special retreat to be connected with other AYAs. If you have any question, please contact shuli@usc.edu or visit aya.usc.edu.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms